6.1 How the Therapist has Interpreted their Reactive State?
6.1.1 Identification with Suffering
“I couldn’t bring it to an end. It held us all in for a while – I don’t know how long…”
(Rhonwyn)
Most of the countertransference experiences recorded in the 9 transcripts seemed to be examples of some form of concordant countertransference (Racker, 1968) (particularly those which were expressed as emotions), where the therapist identified with the suffering of their client. Participants reported to have frequently felt helpless, trapped, tired, frightened, overwhelmed, horrified, lost, vulnerable, sad, angry, and shocked; all feelings which seem to mimic how the client felt at the time of their trauma. Interestingly, therapist‘s counselling sexual assault survivors, especially in cases with children, reported to have felt guilty (for pushing too far for information/procedures), and enraged at the destructive and erosive nature of this crime. Some found themselves visualizing the look on their own child‘s face if they had undergone such a trauma.
Other participants found that trauma cases in general felt very chaotic and fragmented. They understood this to be a ‗mirroring‘ of how the client felt at the time of the trauma or in the therapy room. They were able to bring this countertransference back into the therapeutic context with a careful and well-timed explanation of how they, as the therapist, felt and what they thought it may mean for the client. This often resulted in the benefit of deepening the client‘s experience of ―being heard‖.
Identifying with the client‘s suffering (concordant identification) is a core element of establishing empathy, but only so far as the therapist is aware of their countertransference reactions. The following quote illustrates this point by showing how Tracey identifies with her client‘s intense emotion and existential questions brought on by the impact of trauma exposure:
Trauma, grief and bereavement are the cases that I find tend to impact with me far more intensely than … sort of assertiveness stuff, or some personal development stuff … [It‘s] interesting, because I haven‘t thought about why it might be that way. I think the level of emotion of my client is obviously very much more intense. The personal growth thing, they‘re kind of neutral, you know, the conversation, if I can call it that, just kind of flows, my client just talks. Whereas when its grief, bereavement or trauma or if there‘s intense emotion related, usually tears, usually very graphic descriptions of what they‘re thinking and experiencing, usually lots of real deep grappling on their part of trying to get some meaning. And that‘s what I would be trying to help them to do, is to get a sense of meaning for themselves… Also possibly because when people are grappling with the meaning of life issues, it makes me think about the meaning of life, whereas personal development stuff just doesn‘t have that intensity... (Tracey, pg 3, line 7 – 3)
Here this participant, who initially felt that she was not affected by the trauma case she brought to the interview, began to process how some of her trauma cases do affect her and why. Perhaps there was a certain amount of denial about intense emotions because they are felt to be overwhelming? In the above quote she seems to perceive the processing of intense emotion as leading to a ―grappling‖ of meaning on both her and the client‘s part, with the end result of being left with existential questions/concerns. Another participant, who also connected with the idea of existential issues being at the core of her countertransference experiences, reflected further on the fundamentally ―human topic[s]‖ that she identifies within her client:
…I think what‘s especially difficult [about trauma] is the almost existential questions about that, so: ―What if this had happened?‖ or ―What does this mean about life?‖, ―What does this mean about trust?‖ And those sort of questions are human, you can‘t just leave that in a therapy room. So it‘s sometimes difficult to leave, sort of, crime stories. I think we are trained on how to leave those behind but all the existential questions round, ―Well, I‘m not in control of everything‖, goes on and it‘s quite difficult to realistically deal with that, but also not to ruminate over your client‘s stories. So it‘s hard to know where your thinking stops, you know, whether its client specific or you personally because it‘s such a human topic, you can‘t totally separate it. (Christa, pg 2, line 2 – 10)
There seems to be an element of identification here, where the therapist is struggling to separate out what belongs to her and what belongs to the client in terms of countertransference. The therapist understands this as being caused by the innate
‗humanness‘ of trying to find meaning in suffering. She seems to link these existential issues with a difficulty in leaving the trauma case in the therapy room, highlighting a potential boundary breach. She seems to feel that although identifying with the client is healthy and allows her to connect empathically, it makes it that much more difficult to leave the trauma in the therapy room post session. The difficulty seems to lie in the
‗humanness‘ of the topic which bridges the gap between her sessions and everyday life. The distinction, and thus the boundary, becomes unclear when the topic at hand is so innately human, for example: what does this mean about life and trust?
Two key aspects highlighted here are the level of the therapist‘s awareness and their ability to strike a balance between healthy empathy and identification, and unhealthy over-identification. One of the participants showed a distinct awareness of this process, where empathizing with a traumatised client can lead to fusion and unhealthy over-identification:
…[E]mpathy and then sort of reclaiming one‘s sense of self and a little bit of separateness, occurs all the way in therapy. There‘s that pendulum between sort of fusing with someone and being able to empathise with them, then the danger of merging too much and, you know, the purpose of the merge and fusion, temporary as they are, are for empathy, but one has to then regain [the]
self. Because traumatized people especially are boundary sensitive, and I‘m more conscious of not overdoing it than in fact undoing… Going from empathy to over-identification to obviously merger and fusion are what I‘m
aware of in my head. To locate myself in that, some different things are obviously necessary, it‘s about the balance. But at times, you know, when people have been really neglected and abused it actually helps to come up with a huge dollop of surprise empathy, you know, and it‘s got to be genuinely and authentically given. I have no problem demonstrating horror, exclaiming,
―That really is just absolutely awful.‖ You know, I'm saying it on behalf of them and at times I‘m aware I‘m saying it on behalf of society… It re- establishes some level of humanity. (Rowan, pg 9, line 22 – 37)
Here Rowan feels it a necessary step in showing empathy to merge with a client temporarily and then be able to detach. He feels that if a balance is not struck between merging and detaching then a therapist may fall prey to over-identification. As Rowan explains above, empathy ―re-establishes some level of humanity‖ and when dealing with the innately human topic of creating meaning out of suffering, it seems difficult for therapists to remain objective and detached. Rowan, however, appears to have managed the process in an enlightened and helpful way by giving voice to the client‘s feelings and expressing empathy without blurring boundaries. He achieves this through making a distinction between a ‗passive‘ kind of empathy which results in fusion (not necessarily pathological) and sometimes over-identification; and the
‗communication of empathy‘ which uses the countertransference to emerge from
‗identification with suffering‘. This emergence or separation allows the therapist to notice the client‘s suffering and is an act of care on ‗behalf of society‘. This, however, is a double-edged sword as his advocation on behalf of society may further emphasize the ‗human‘ dimension of trauma, as discussed above, which can make one more vulnerable to experiences associated with vicarious traumatisation – further highlighting that what is good for the client is not always so for the therapist.